Diagnosing Chronic Pancreatitis
Many patients with chronic pancreatitis struggle to get an accurate, timely diagnosis. This is because chronic pancreatitis is a rare disease and there is no one test that can reliably diagnose it. It can also be difficult for doctors to spot the signs of chronic pancreatitis, which may lead to misdiagnosis or delayed diagnosis. To diagnose chronic pancreatitis, doctors need to consider a patient’s medical history and symptoms, and rule out other possible conditions (this process is called differential diagnosis). This means that getting a diagnosis can take some time and may require multiple tests. But, with good communication and teamwork between patients and doctors, a diagnosis can be reached.
How is chronic pancreatitis diagnosed?
To diagnose chronic pancreatitis (CP), a doctor should look at the following to help determine whether or not your pancreas may be inflamed:
- Patient symptoms
- Imaging and laboratory tests
- Patient and family history
Medical Imaging for Chronic Pancreatitis
Medical imaging may be used by your doctor to help with a diagnosis of chronic pancreatitis. Some imaging tests may be more helpful than others.
Imaging used to diagnose chronic pancreatitis includes:
- Endoscopic Ultrasound (EUS) to get an accurate view of pancreatic inflammation, fibrosis (scarring), and blockages of the pancreatic duct or bile duct. This type of imaging test involves placing a thin, flexible tube (endoscope) against the wall of the stomach where the pancreas is and a device that uses sound waves (ultrasound). Endoscopic ultrasounds are one of the best tests for the early detection of chronic pancreatitis, allowing doctors to see details other types of imaging cannot.
- Magnetic resonance imaging (MRI) to look for irregularities in the gallbladder, pancreas, and ducts. This type of imaging will help doctors see things that CT scans have a hard time detecting, such as changes to pancreatic ducts and glands.
- Computerized tomography (CT) Scan to look for the presence of gallstones and evaluate the degree of inflammation in the pancreas. However, while this scan is heavily used in the U.S. medical system, it may not be the best way to diagnose chronic pancreatitis. Statistically, chronic pancreatitis only shows up on CT scans in about 10% of patients. If you believe you meet the criteria for CP, but weren’t diagnosed following a CT scan, you may want to ask for additional tests.
Laboratory Tests for Chronic Pancreatitis
Laboratory tests can also help doctors determine if you have chronic pancreatitis. These tests look for signs of inflammation and other conditions related to acute and chronic pancreatitis, such as malabsorption (poor absorption of nutrients).
Laboratory tests for pancreatitis include:
- Lipase Test to measure lipase levels in your blood. Lipase is a digestive enzyme that is primarily made in your pancreas and helps your body digest fats. When lipase levels are too high, it indicates that there is damage to your pancreas and you may have acute or chronic pancreatitis.
- Amylase Test to measure amylase levels in your blood or urine (pee). Like lipase, amylase is also primarily made in your pancreas. However, this digestive enzyme helps you process carbohydrates. When amylase levels are too high or too low, it can be a sign of a problem with your pancreas or salivary glands (which make saliva).
- Stool (Pancreatic Elastase) Test to measure elastase levels in your stool (poop). This stool test helps determine if your elastase levels are low, which shows that your pancreas is not producing enough enzymes (EPI) to digest fat. This occurs when about 90% of the pancreas has been damaged.
- C-Reactive Protein (CRP) Test to measure how much CRP protein is in your blood. When CRP proteins are high, it indicates that there is inflammation somewhere in your body. However, it can’t show where it’s coming from or what’s causing it. Doctors will need to consider other symptoms to accurately diagnose chronic pancreatitis with this test.
- Triglycerides Test (lipid panel) to measure triglyceride levels in your blood. Triglycerides are a type of waxy fat that circulates in your blood and helps give your body energy (calories). Hypertriglyceridemia (very high triglycerides) can cause pancreatitis.
- Bilirubin Test to measure bilirubin levels in your blood. Bilirubin is a yellow substance found in bile that is made when old red blood cells are broken down. Bilirubin tests can help doctors see if there may be a blockage in your bile ducts (located in the liver and gallbladder) which suggests gallstone disease and can lead to pancreatitis.
- Fat-Soluble Vitamin Test (A, D, E, K) to measure vitamin levels in your blood. Chronic pancreatitis can lead to low levels of certain vitamins. When fat-soluble vitamins are low it indicates chronic malabsorption, meaning you’re not getting the nutrition you need, possibly due to chronic pancreatitis.
Patient and Family History of Chronic Pancreatitis
It’s important for doctors to get a full history of patients presenting with pancreatitis; however, there are many misconceptions about the disease that can prevent this. Doctors should ask about and patients should share the following information to help accurately diagnose the disease:
- Family history of pancreatitis or pancreatic cancer to see if there’s a genetic predisposition (passed down from a family member) of pancreatitis
- Known syndromes or autoimmune conditions to see if there is an association between another condition and pancreatitis
Learn more about the causes of pancreatitis.
You are your own best advocate when it comes to getting an accurate diagnosis. If you suspect you have chronic pancreatitis, consider these four main key takeaways when it comes to getting diagnosed:
- Make sure a good physical exam is performed
- Ask about inflammatory markers
- Ask for an endoscopic ultrasound when all other imaging tests are negative
- Make sure your doctor conducts a thorough investigation (patient/family history) of the causes before labeling your pancreatitis as idiopathic (without a known cause) or alcoholic